Willows Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home has been converted from a large three storey house close the centre of Birkdale, near Southport. The home can accommodate up to 28 people with a variety of nursing needs. There were 21 people in residence at the time of the inspection.

This was an unannounced inspection and it took place on 8 and 11 May 2018.

At the last comprehensive inspection in April 2017 we found a breach of regulations with in respect to, induction and training standards for new staff and medicines management. The service was rated as ‘Requires improvement’. We followed this up in September 2017 to review the breaches of regulations we found improvements and the breaches had been met. We did not review the overall quality rating at that time and the home remained ‘Requires improvement’.

On this inspection we found improvements had been sustained and the home had continued to develop. On this inspection we rated the service as ‘Good’.

A manager was in post who was in the process of becoming registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The manager had previous experience of working at senior level with the registered provider.

Potential risks to people using the service were clearly identified. Effective care plans had been agreed with people so that potential risks could be reduced.

Medicines were safely stored and administered in accordance with best-practice and people’s individual preferences. Nursing staff were updated and trained in administration. The records indicated that medicines were administered correctly and were subject to regular audit.

Key documentation included attention to ensuring peoples consent to any care and treatment was recorded and operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

The Willows had improved much of their key assessment and care planning documentation and it was now clear and detailed regarding peoples care. People’s needs were assessed and recorded by suitably qualified and experienced staff. Care and support were delivered in line with current legislation and best-practice.

The service had continued to develop quality monitoring processes and the manager had support from senior managers in the organisation.

Policies and procedures provided guidance to staff regarding expectations and performance. These included policies regarding equality and diversity. Staff were clear about the need to support people’s rights and needs and recognised individual needs. Care records contained information about people’s sexuality, ethnicity, gender and other protected characteristics. We discussed ways during feedback how this area could be developed further; this included attention to developing the visible cues in the environment to accommodate people living with dementia.

People using the service and staff were involved in discussions about the service and were asked to share their views. This was achieved through daily contact by the managers and staff and regular surveys and meetings. These provided very positive responses regarding people's care.

Overall the service maintained effective systems to safeguard people from abuse and the service had worked effectively with the local safeguarding team when needed.

We saw evidence that the service learned from incidents and issues identified during audits. Records showed evidence of review by senior managers.

The service ensured that

We carried out an unannounced comprehensive inspection of this service in April 2017. We found the home to be rated ‘Requires improvement’ and we found one breach of regulations regarding the way medicines were managed in the home.

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on 28 September 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This report only covers two questions we normally asked of services; ‘Is the service safe?’ and ‘Is the service Well led?’

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Willows Nursing Home’ on our website at www.cqc.org.uk.

The Willows Nursing Home provides accommodation for up to 28 people who require nursing care.

There was a new manager who had started in post in the last month; they were in the process of applying for registration with the Care Quality Commission [CQC]. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the service had made improvements to the way medicines were administered and managed; medication administration was safe. We found the breach had now been met.

The improvements related to previous areas of concern regarding the recording and storage of ‘thickening agents’ [to thicken drinks for people with swallowing difficulties] and application of external preparations such as creams.

We made a recommendation regarding the way applications of creams were recorded. There were other improvements to recording of medicine records also discussed.

The Willows is nursing home that has been converted from a large three storey house close the centre of Birkdale, near Southport. All rooms are for one person and seven rooms have an ensuite toilet and wash basin. The home can accommodate up to 28 people with a variety of nursing needs.

This inspection was carried out over two days on 12-13 April 2017 and was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found some anomalies with the way some medicines were being recorded and monitored. This meant there was a risk these medicines were not being administered consistently. We found the checking and auditing systems of medicines needed improving to ensure all anomalies were being identified.

You can see what action we told the provider to take at the back of the full version of this report.

Staff said they were supported through induction, appraisal and the home’s training programme. We identified some areas that needed further development and found that some of these had also been identified by the managers previously such as the full introduction of the Care Certificate.

We made a recommendation regarding this.

People we spoke with said they were happy living at the Willows. Staff mostly interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people. We did make some observations that staff did not always communicate appropriately and offer reassurance when carrying out care tasks; this was fed back to the registered manager as an issue for further staff development.

We made a recommendation regarding this.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

The registered manager and senior managers for the provider were able to evidence a range of quality assurance processes and audits carried out at the home. We found some supporting management systems continued to be developed such as, consistency around staff induction and key areas such as, medicines management needed improving.

We found the home supported people to provide effective outcomes for their health and wellbeing. We saw there was effective referral and liaison with health care professionals when needed to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there were sufficient staff on duty to meet people’s care needs.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable and safe environment.

The home was clean and we there were systems in place to manage the control of infection.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

We carried out an unannounced comprehensive inspection of this service in February 2016 when one breach of legal requirement was found. The breach of regulation was because we had concerns about the lack of staff training and support. We asked the provider to take action to address this concern.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 6 July 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This covered one question we normally asked of services; whether they are 'effective’. The question 'was the service safe?', 'was the service caring?', 'was the service responsive?' and 'was the service well led?' were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Willows Nursing Home on our website at www.cqc.org.uk.

Willows Nursing Home provides care and support for up to 28 people with a variety of nursing needs.

A manager was in post though they were not registered with us (Care Quality Commission) as yet. Following our inspection the manager informed us they had submitted their application to us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the service had made improvements and the breach had been met. Staff were supported and trained to ensure they met people’s needs.

The provider had now set up an academy with training managers to oversee the training requirements for staff employed at the Dovehaven homes. This was to ensure the staff have the skills, knowledge and expertise to meet people's individual needs and to further their professional development and learning. Staff attended a rolling programme of training which included formal qualifications in care and subjects such as moving and handling, safeguarding adults, infection control, fire safety and food hygiene.

Systems were in place to support staff and this included the provision of staff meetings and supervision sessions held on a one to one basis by the manager with staff.

We carried out an unannounced inspection of The Willows Nursing Home on 8 February 2016.

The Willows is a nursing home that has been converted from a large three storey house in Birkdale, near Southport. All rooms are for one person and seven rooms have an en suite toilet and wash basin. The home can accommodate up to 30 people with a variety of nursing needs. There is a passenger lift and there is only one first floor room that is not accessible using the lift. There is a landscaped garden to the rear of the property and a small car park at the front of the home.

At the time of the inspection a registered manager was not in post. The registered manager had resigned from their post shortly before the inspection.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found a breach of regulation in relation to the training of new staff.

You can see what action we told the provider to take at the back of the full version of the report.

We have recommended the service consider best practice guidance regarding the storage and administration of medicines.

We have recommended the service consider best practice guidance regarding the development of the environment for people living with dementia.

All of the people that we spoke with told us that they felt safe living at the home. However, we saw that a sluice room door was unlocked throughout the inspection giving access to dangerous chemicals. We also saw that a sharps bin was stored in a communal area which presented an avoidable risk to people living at the home.

Staff understood the different types of abuse and what signs to look out for. They also understood what to do if they suspected that abuse had taken place.

The home had processes in place to assess and review risk. Risks were assessed when people first came to live at the home and were reviewed regularly.

The home operated in accordance with the principles of the Mental Capacity Act (2005). The home had assessed people’s capacity, submitted applications to the local authority and notified the commission as authorisations were processed.

People living at the home told us that they enjoyed the meals and were offered a choice. The food provided was of a high standard and drinks were readily available.

The design of the building meant that it was initially difficult to navigate and signage was limited. In addition, the building had not been decorated or adapted to meet the specific needs of people living with dementia.

Everyone that we spoke with told us that the staff were caring and kind. Staff knew what was expected of them and were motivated to provide good quality, safe care.

The managers that we spoke with were aware of the day-to-day culture within the home and recognised the issues and priorities.

The home operated processes to monitor safety and quality in a number of areas. We saw that audits had been completed in accordance with a monthly schedule and had identified areas for improvement, however they had been ineffective in identifying other issues.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

The Registered Manager was responsible for organising the staff rotas. The manager told us, "I always consider the needs of residents when I am putting the rotas together." This helped ensure all people living in the nursing home had their needs met at all times.

All staff members had received safeguarding training. The staff we spoke with were aware of their roles and responsibilities which meant people were not put at risk. One person we spoke with told us, "I feel so safe - we are well looked after."

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

People living at the nursing home were involved in assessing their care needs and writing their individual care plans. People told us they were happy with the care they received which meant their needs were being met.

We observed care in communal areas and it was clear staff members had a good knowledge of the support required by each person. Staff had received training which helped ensure people`s needs were met. One person told us, "This is a very happy home - it always has been."

Is the service caring?

We saw people were cared for, and supported, by patient staff who took time to understand people`s needs. Staff members gave constant encouragement to people living in the care home. When care was required, for example at meal times, staff members were there to provide appropriate support.

One family visitor told us, "It`s a tribute to them (staff) that we have seen such a big improvement - mentally and physically." People`s choices and preferences had been recorded in their care plans and support was provided in accordance with their wishes. This meant their needs were being met by attentive staff members.

Is the service responsive?

People living at the nursing home were regularly involved in activities both inside and outside the home. The provider told us, "We have our own minibus which gets us out and about - but a lot depends on the weather." This meant people were actively involved in their local community and beyond.

The provider had a complaints procedure in place which people were aware of. We saw one complaint that had been recorded and responded to appropriately. We noted the complainant was happy with the outcome. This meant complaints and concerns were listened to and acted on within an acceptable time frame.

Is the service well-led?

We saw the provider worked well with other agencies which meant people received care when they needed it. All professional visits and appointments had been recorded for all people living in the care home.

The provider had a quality assurance system in place. Meetings were held for staff members and people living in the care home and we saw that any issues raised were responded to. We were told by the provider that, "Senior staff members attended strategy meetings with the owners and discussed what`s working and what`s not working." This meant the quality of service being provided was being monitored which helped ensure the care and support at the nursing home continued to improve.

We spoke with two people who were able to tell us their views and experiences of the service. Both expressed satisfaction with the care and support provided to them. One person told us how much their health and wellbeing had improved over the time they had lived at the Willows. We spoke with a person who was visiting their relative who lived in the home. They said “This is a home from home and they always make you feel welcome.” Their relative had a high level of nursing needs and we were told they had full confidence in the nursing staff team to meet those needs.

From speaking to people, their relatives and reviewing care records we found that consent was being obtained from people about their care and treatment and people were receiving care and support that met their individual needs. We found the building and grounds were being well maintained and were safe. We also checked recruitment records and found appropriate checks had taken place to ensure people were suitable to work within the home.

We found improvements had been made since our last inspection in December 2012 when we found that some care plans and risk assessments were not accurate. At this inspection, we found this concern had been addressed. We looked at the care records of three people who lived at the home. We found they had enough information to help staff to care for and meet people’s needs.

We spoke with six people who lived at The Willows and three visiting relatives. Without exception, everyone we spoke with was positive about the quality of care at The Willows. We heard comments such as such “It is one of the best homes in the area”, “I am delighted with the care that my relatives receives here. I wish we had come here sooner” and “I am very content with the way things are.” People were also full of praise for the manager and care home owners.

We saw staff caring for people in a calm and respectful manner. It was clear that staff had a good understanding of people’s needs and were flexible in their approach when dealing with people who had dementia or were anxious.

We spoke with three staff members who told us they were well supported and had appropriate training to undertake their roles. However, we found that that the care records were not always written and updated as we would expect.